ASC Billing Best Practice: Conduct Regular Payment Audits

Chris Davis, billing supervisor at MCG Billing, recommends ASCs conduct regular payment audits to make sure carriers are paying for procedures as laid out in your contract. Every 4-6 months, collect information on denied and processed claims for your five biggest payors and five most profitable procedures. “You want to see your carriers paying consistently on your five biggest procedures and paying according to the contract,” Ms. Davis says. Look at your allowed amounts and calculate whether those are the amounts you are receiving from the carrier.

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Margie Williams, accounts receivable manager at MCG Billing, says if you find during a payment audit that one of your major carriers has paid an operating expense at a lesser or higher value than your allowed amount, contact the provider and let them know. Ask the provider to investigate the issue, Ms. Williams says. You will generally hear back within 15 days from the carrier and find out if you have overlooked something in the contract. If the carrier has been paying you at a lower rate than your contract specifies, Ms. Williams says you should resubmit the claims for consideration to receive the additional payment.

The take-home lesson: You won’t know if you’re receiving correct reimbursements unless you regularly review your contracts and payments, Ms. Williams says. Don’t be afraid to contact your carriers and discuss discrepancies. The carrier will want to know if they’re paying too little — or too much — so it’s in your best interest to be open and honest about your payments.

Learn more about MCG Billing.

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